Subtotal Versus Total Cholecystectomy in Complicated Cholecystitis Daniel Kaplan, BA, Kenji Inaba, MD, Konstantinos Chouliaras, MD, Garren M. I. Low, MS, Elizabeth Benjamin, MD, Lydia Lam, MD, Daniel Grabo, MD, Demetrios Demetriades, MD, PhD LAC+USC Medical Center, Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA
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Subtotal Versus Total Cholecystectomy in Complicated
Cholecystitis
Daniel Kaplan, BA, Kenji Inaba, MD, Konstantinos Chouliaras, MD, Garren M. I. Low, MS, Elizabeth Benjamin, MD, Lydia Lam, MD,
Daniel Grabo, MD, Demetrios Demetriades, MD, PhD
LAC+USC Medical Center, Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA
• No disclosures
Financial Disclosures
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• 10-15% of adults developed world
• ~$6.2 billion annually
• Lap chole most common elective surgery US
Burden of Gallstone Disease
3Stinton L, Shaffer, E. Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer. Gut and Liver. 2012. Apr;6(2): 172-187.
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Difficult Cholecystectomy• Severe inflammation • Fibrosis• Aberrant anatomy
Conversion to Open total chole• Conversion rates vary btw 1.5-10%
Tang B, Cuschieri A. Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg. 2006. (10):1081-1091.
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Subtotal Cholecystectomy• Introduced by
Bornman et al. 1985 to reduce CBD injury
• Involves excision of anterior wall and closure of cystic duct from within GB
Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche J. Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg. 1998 Jul;85(7):904-6.
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Objective• To compare the outcomes between
subtotal cholecystectomy vs. open total cholecystectomy in patients with complicated cholecystitis